Many years ago, two junior doctors presented the last patient on the ward round to me. He was a 70 year old man who had been having problems walking and swallowing for a few weeks. His examination was fine, all his tests were normal and they had no idea what was wrong with him. He looked quite well from the end of the bed. I said hello and asked if I could look at his legs. I pulled back the covers and stared at his thigh muscles for a few minutes. The junior doctors leaned over to see what I was looking at. And there they were - fine fasciculations (abnormal movements) of his thigh muscles. It dawned on the doctors when they saw this. The patient had Motor Neurone Disease.Doctors in training experience these moments when the consultant appears to 'just know' what the problem is (of course, thinking you 'just know' is not the same as actually knowing!) Gary Klein, an expert on intuition, says that many people think of intuition as something you are born with. But there is no evidence that some people are blessed with intuition and others are not. Intuition grows out of experience. Or as Malcolm Gladwell puts it in his book 'Blink', it is 'thinking without thinking' - but actually the result of a vast databank of previous experiences.Klein says there are many things experts see that are invisible to everyone else:

Patterns that novices do not notice

Anomalies

The big picture

The way things work

Events that either have already happened or are going to happen

Differences that are too small for novices to detect

Their own limitations

Experts see their world differently. They see things the rest of us cannot. Often they do not realise that the rest of us are unable to detect what seems obvious to them. Since intuition is a big part of medical practice, teaching this is a challenge, but this kind of pattern recognising can be unpicked so others can learn from it.Klein G. Sources of Power. How people make decisions. MIT Press, 1998.Gladwell M. Blink: the power of thinking without thinking. Penguin, 2006.